Date of Birth

MM

DD

YYYY

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you lived in Georgia for the past 6 months?

Yes

No

Date of Birth

MM

DD

YYYY

Phone

(###)

###

####

Address

(if different from Spouse 1)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Marriage

MM

DD

YYYY

Date of Separation

(can be approximate)

MM

DD

YYYY

Have there been any other cases between the parties?

Yes

No

Is either party currently pregnant?

Yes

No

Are there any allegations of domestic violence by either party?

Yes

No

Not sure

Alimony - Is either party going to be paying alimony to the other?

Yes

No

Not sure

Attorney's Fees

Each responsible for their own

Splitting costs evenly

Other

Income Taxes - have taxes for the most recent tax year been filed yet?

Yes

No

If not, who will be responsible for having them filed?

Spouse 1

Spouse 2

Ready to Submit? *

Check either box below, then "Submit" when you have completed your questionnaire.